Duties

The prevalence and incidence of patients with end stage renal disease (ESRD) has increased steadily in the past decades. There were around 55000 ESRD patients receiving dialytic therapy at the end of year 2009; among them, 50200 (92%) were undergoing maintenance hemodialysis and 4800 (8%) receiving peritoneal dialysis. It is ominous to suffer from ESRD but with the progress in modern medicine, these patients are able to survive using renal replacement therapy. There are three types of renal replacement therapy:(1) kidney transplantation, (2) hemodialysis, and (3) peritoneal dialysis. Each of them incurs tremendous medical expenditure. However, with Taiwan’s economic prosperity and the implementation of the National Health Insurance Policy, all patients have chance to receive these treatments at little cost.

The doctors and nurses of the Division of Nephrology endeavor to improve our therapeutic standards and the quality of care through continuing education. We have implemented a prevention project for Chronic Kidney Disease (CKD) with integrated healthcare and education programs, and extend our care to patients with pre-ESRD CKDs, in order to reduce the high incident rates of ESRD in Taiwan in the future. There are Division of Nephrology at RenAi, Heping, ZhongXiao, ZhongXin and YangMing branch and all have hemodialysis and peritoneal dialysis facilities.

Doctors in the Division of Nephrology

There are 13 attending physicians in the five branch sites of Taipei City Hospital (TPECH). All of them are board-certified nephrologists. In addition, we have nephrology fellows in training, chief residents as well as rotating residents for inpatient care. These younger doctors will soon become the manpower in this Section once their training programs are completed.

Clinical Services available include hemodialysis and peritoneal dialysis as well as diagnosis and treatment of all kinds of diseases of the kidney or urinary system

[1] Hemodialysis: There are 25 hemodialysis beds at the ZhongXiao branch, 17 beds at the ZhongXin branch, 30 beds at the YangMing branch, 36 beds at the Heping branch and 30 beds at RenAi branch. Peritoneal dialysis units are also available all five branches. We implement a one-time-use policy for all, including the high-efficiency or high-flux, dialyzers. Nocturnal hemodialysis is regularly available at most of the branch sites. The monthly hemodialysis sessions exceeded 6600 across the TPECH. Many patients have undergone hemodialysis for 10 years or more and quite a few have been treated for more than 20 years in our Section.

[2] Peritoneal dialysis: Peritoneal dialysis (PD) includes both CAPD and automated peritoneal dialysis (APD) modalities. They are the alternate treatments currently available for patients with ESRD. As a result of the fact that they result in greater hemodynamic stability (less profound fluctuations in the patient’s blood pressure, uremic toxins and plasma electrolytes, which are typical during hemodialysis), PDs are most suitable for elderly patients, patients with heart diseases or patients who are unable to tolerate long-term hemodialyses. Furthermore, if a patient cannot havc an appropriate fistula for vascular access during hemodialysis constructed, then PD is a valid option. As PD is manipulated by patients themselves at home or at work, they are good options for patients living far from a hospital, for those whose movement is handicapped or those who are unable to return to hospital on a regular schedule due to work or study. Peritoneal dialysis units from TPECH service patients from outside Taipei City too including patients from Penghu. We have provided peritoneal treatment for more than 10 years. There 60 patients at the RenAi branch and 20 patients in the Heping branch. Some of our patients have been receiving PDs for over 10 years. There are four peritoneal dialysis nurses working in our PD settings and we are one of the qualified training centers for PD nurses and are accredited by the TSN.

[3] Other services: Management of other kidney and urinary system diseases are also part of our area of expertise. There are independent subspecialty wards at two branch sites, and the rest share their wards with other subspecialties of the Department of Internal Medicine. Ultrasound examinations are regularly done. Percutaneous renal biopsies are also an available procedure.

FUTURE PROSPECTIVES: As patients suffering from ESRD continue to grow at a significant rate in Taiwan, the Nephrological Section intends to expand our hemodialysis capacity to fulfill those needs. In addition, PD services will be established at other branch sites as an alternate choice. Furthermore, we would like to develop an integrated service delivery system in order to be better able to take care of the patients at the pre-ESRD stage. Health education and health promotion need to be part of such a system. By so doing, we hope that our quality of care will improve and that the high incident rate of ESRD in Taiwan will be brought down.